By Phyllis Kaniss | By the time Jerald Winakur’s father reached the age of 81, he had survived two heart attacks and a bout of prostate cancer, so the shortness of breath that led to his hospital admission and the diagnosis of congestive heart failure did not seem very troubling. But while the elder Winakur responded well to diuretics, his hospital stay proved disorienting and he soon began experiencing paranoia and delusions that were eventually traced to the onset of dementia.

In Memory Lessons, Winakur chronicles his father’s mental and physical deterioration and the emotional tumult involved in taking on an ever-growing role in managing his father’s care. What makes his story so unusual—and so valuable—is that Winakur writes not just as a son coping with his father’s precipitous decline but also as a geriatrician trained to treat this very population of patients, referred to informally by clinicians as the “old old.” As this involving memoir makes clear, Winakur the doctor’s understanding of the physical causes of his father’s illness did not make any easier the heartbreaking decisions that faced Winakur the son.

Indeed, at the heart of this book is the recognition that one of the most difficult parts of dealing with an elderly parent’s failing health is the number of decisions facing a son or daughter—and the haunting fear of not making the right one. Although Winakur was fortunate to be able to share his father’s caretaking with an involved brother, his (almost blind) mother, and a caring health aide, he was the one ultimately responsible for the big decisions. And from watching the families of his patients, he understands all too well the feelings that go along with that responsibility:

You feel guilty and powerless and abandoned and angry and bereft. You have decisions to make and no one to guide you … Your siblings are obstinate or in denial or still angry over some long ago slight, some falling out which seems silly now … You are afraid you will make a mistake, decide the wrong thing, choose the wrong path.

It is that very loneliness that makes Winakur’s story a solace to any reader confronting the same painful journey. The book will strike a poignant chord in anyone who has had to take the car keys away from a mother or father who could no longer see road signs, or decide between a nursing home and keeping a loved one at home with the help of aides and hospital beds.

The decisions are all the more difficult because of the role reversal they involve. Winakur calls it the “inescapable truth: Our parents will become our children if they live long enough.” He captures the jarring quality of this shift by moving back and forth in time, juxtaposing portraits of himself as a child—“Jerry-boy” to a father who lovingly led him on bird-watching jaunts—with present day images of the middle-aged doctor ministering to the frail old man.

The book also captures how sudden an elder’s decline can be, and how unprepared are their adult children to deal with the aftermath: “One day you may get a call. Your father is confused and was found wandering the streets many blocks from his home. Or your mother had a stroke and is now in an intensive care unit. Or he broke his hip after he fell off a ladder.” Rushing home to sit at a hospital bedside, sick at heart after coming face-to-face with the physical deterioration they had avoided confronting until now, they must confront the reality of what happens next. Can their mother or father go home? Can they go home? Can someone else deal with it all? Winakur minces no words in his response: “Stop deluding yourself. It’s time to have some tough discussions—sisters, brothers, Mom and Dad. It’s time to make plans.”

While much of the book’s value comes from Winakur’s personal experience, he also makes many clear-eyed observations about the failings of the healthcare system in dealing with the elderly. Medicare policies, he claims, reward procedures and technical interventions over the kind of vital but time-consuming “cognitive” services that geriatricians like Winakur provide. As a result, many of his primary-care colleagues no longer see Medicare patients, because, as one colleague told him, “It just takes so long for them to dress and undress and climb off and on the table from their walkers and wheelchairs … It just doesn’t pay.”

Even more disturbing are the questions he raises about the future scarcity of geriatric doctors in the face of the aging of the Baby Boomers. (By Winakur’s estimates, the number of Americans over 85 will quadruple in the next 45 years.) “Who will minister to us and not just do things to us?” he asks. He also rails against “futile care” for the elderly and argues that healthcare resources should be devoted to more productive use.

In describing his own respectful and deliberate approach to treating the “old old,” Winakur provides a convincing portrait of the importance of geriatric care to improving the quality of life—and the experience of death—for elderly patients and their families. But he is perhaps at his strongest when he reflects on his own situation, exquisitely capturing the complexity of emotions involved in confronting parents in old age.

As much as Winakur evokes our sympathy and admiration, it must be said that he never has to confront two major obstacles that others face in caring for aging parents: navigating the medical system and paying the bills. Knowing when to bother an on-call doctor after hours, or when to take a mother or father to the emergency room (often against their will) can be confounding to many, while others lie awake at night worrying what will happen to that vital but expensive round-the-clock aide when the money runs out. But these omissions should not detract from Memory Lessons’ value as a moving portrait of aging and familial love.

Phyllis Kaniss CW’72, an occasional contributor to the Gazette, is executive director of the American Academy of Political and Social Science.